The gap between model or potential solutions and solutions that work in the real world – the translational gap — is arguably the greatest challenge we have in healthcare, and is something seen in both medical science and in digital health.

Translational Gap in Medical Science

The single most important lesson I learned from my many years as a bench scientist was how fragile most data are, whether presented by a colleague at lab meeting or (especially) if published by a leading academic in a high-profile journal.  It was not uncommon to watch colleagues spend months or even years trying to build upon an exciting reported finding, only to eventually discover the underlying result was not reproducible.

This turns out to be a problem not only for other university researchers, but also for industry scientists who are trying to translate promising scientific findings into actual treatments for patients; obviously, if the underlying science doesn’t hold up, there isn’t anything to translate.  Innovative analyses by John Ioannidis, now at Stanford, and more recently by scientists from Bayer and Amgen, have highlighted the surprisingly prevalence of this problem.

An invaluable function of industry (as I’ve argued) is pressure-testing academic results, and seeing if they are as robust and generalizable as the authors hope and expect.  One reason early-stage VC funding in the life sciences is so hard to come by these days is that investors have learned through painful experience not to take hot published data at face value.

The challenge of data reproducibility also represents an opportunity – if you can demonstrate your intriguing results are robust, and achievable by others, you’ve effectively differentiated yourself from a lot of the competition.

That’s the logic, anyway, behind a new effort called the Reproducibility Initiative, which aims to provide a mechanism for scientists to show their results are reproducible  by paying a third party to replicate them (see this Reuters article by Sharon Begley, the science journalist who I suspect has done the most to focus attention on the need for better translation).  A PLoS journal has committed to publishing such validation studies, and Nature journals that publish original studies have indicated (according to this excellent Carl Zimmer article in Slate) that they will link to subsequent validation publications.

I’m a bit skeptical that this initiative will actually catch on (and I also wonder what fraction of academic studies are even amenable to this approach); however, the very existence of this effort highlights the magnitude of the challenge we now face in bridging the gap between a self-sustaining academic enterprise that thrives on journal publications and a struggling medical products industry that requires a far higher (and underappreciated) standard of proof in order to be successful.

Translational Gap in Digital Health

The most significant gap that I’ve seen in digital health is between the seasoned clinicians and other healthcare providers who arguably have the best sense of the problems that need to be solved, and the enthusiastic but medically naive technologists and entrepreneurs eager to offer solutions.

Most of the digital health entrepreneurs I’ve met – even those who see themselves coming from the clinical side rather than the technology side – have remarkably  little medical experience, something that comes across not only in the problems described and solutions envisioned, but also more generally in the failure of many entrepreneurs to grasp the gravitas of medicine, and to appreciate the range and depth of fears and concerns experienced by patients contending with serious or chronic conditions.

Meanwhile, the truly experienced physicians and providers immersed in patient care tend to be consumed with – that’s right – patient care, and often haven’t either the time or inclination to consider entrepreneurial solutions to the problems they encounter.   They may have a comparatively full and nuanced appreciation of the problems to be solved, but may be disinclined to leave their established comfort zone and think about new, technologically-enabled solutions.

Ideally, this challenge should also represent an opportunity; I suspect experienced clinicians encounter specific problems every day that could be solved, perhaps in a generalizable and widely-applicable fashion, by a competent entrepreneur.

Failure to involve such seasoned physicians more fully in digital health will result in a lot more of what I’m seeing now – cutsie, tractionless health apps that might appeal to a young kid’s (or inexperienced tech VC’s) idea of what doctors do, rather than addressing a real pain point experienced by doctors and other medical providers.  (See also this excellent recent post by Dr. Jay Chyung of the consultancy Recon Strategy about the need to ensure health data analytics efforts are focused on actual problems.  [Disclosure: I've previously co-authored several EMR strategy articles with Recon Strategy partner Tory Wolff.])

Enterprises seeking to catalyze digital health are doing a great job drawing in young entrepreneurs, energized medical and graduate students, and junior med school faculty members – a tremendous achievement.

However, I suspect durable success in digital health will also depend upon the ability to access the insights of the experienced physicians who are less focused on disrupting medicine, and are consumed instead with the profound, worthy responsibility of delivering it.

David Shaywitz is co-founder of the Center for Assessment Technology and Continuous Health (CATCH) in Boston.  He is a strategist at a biopharmaceutical company in South San Francisco. You can follow him at hispersonal website. This post originally appeared on Forbes.

Share on Twitter

1 Response for “Closing the Translational Gap: A Challenge Facing Innovators in Medical Science — and in Digital Health”

  1. Pete Schmidt says:

    Some great points. Although we commonly think of translational medicine in terms of drug discovery (see, for example, Francis Collins’s article on this http://stm.sciencemag.org/content/3/90/90cm17.abstract), in reality American healthcare needs translation of basic ideas from across science and engineering into the clinic. Computer scientists and tech entrepreneurs face the same challenges that biologists do — they don’t understand the nuances of the clinic. I have, in my career, achieved success in translating basic science to the clinic (and had some formative failures). Success came from forming multidisciplinary teams of scientists, clinicians, and business people/entrepreneurs. I used to run a company that had good success working with Kaiser on chronic disease management, where our success came from bringing entrepreneurs and computer scientists (my company) together with clinicians and health administrators (Kaiser). It is just as wrong to try to introduce tech innovation to healthcare without including expert technologists as it is to try to do so without expert clinicians. A pervasive problem in medicine is that groups of physicians brainstorming a problem rarely realize that another academic discipline should be integrated into the discussion. I’ve reviewed articles on the economics of healthcare written without an economist — and that suffered for it. They key to translational medicine is understanding that we are translating SOMETHING into medicine, and it takes an expert in that something as well as clinicians to achieve it.

Leave a Reply

THCB BLOGGERS

FROM THE VAULT

The Power of Small Why Doctors Shouldn't Be Healers Big Data in Healthcare. Good or Evil? Depends on the Dollars. California's Proposition 46 Narrow Networking
MASTHEAD STUFF

MATTHEW HOLT
Founder & Publisher

JOHN IRVINE
Executive Editor

JONATHAN HALVORSON
Editor

JOE FLOWER
Contributing Editor

MICHAEL MILLENSON
Contributing Editor

ALEX EPSTEIN
Director of Digital Media

MICHELLE NOTEBOOM Business Development

MUNIA MITRA, MD
Clinical Medicine

Vikram Khanna
Editor-At-Large, Wellness

THCB FROM A-Z

FOLLOW US ON TWITTER
@THCBStaff

WHERE IN THE WORLD WE ARE

The Health Care Blog (THCB) is based in San Francisco. We were founded in 2004 by Matthew Holt and John Irvine.

MEDIA REQUESTS

Interview Requests + Bookings. We like to talk. E-mail us.

BLOGGING
Yes. We're looking for bloggers. Send us your posts.

STORY TIPS
Breaking health care story? Drop us an e-mail.

CROSSPOSTS

We frequently accept crossposts from smaller blogs and major U.S. and International publications. You'll need syndication rights. Email a link to your submission.

WHAT WE'RE LOOKING FOR

Op-eds. Crossposts. Columns. Great ideas for improving the health care system. Pitches for healthcare-focused startups and business.Write ups of original research. Reviews of new healthcare products and startups. Data-driven analysis of health care trends. Policy proposals. E-mail us a copy of your piece in the body of your email or as a Google Doc. No phone calls please!

THCB PRESS

Healthcare focused e-books and videos for distribution via THCB and other channels like Amazon and Smashwords. Want to get involved? Send us a note telling us what you have in mind. Proposals should be no more than one page in length.

HEALTH SYSTEM $#@!!!
If you've healthcare professional or consumer and have had a recent experience with the U.S. health care system, either for good or bad, that you want the world to know about, tell us about it. Have a good health care story you think we should know about? Send story ideas and tips to editor@thehealthcareblog.com.

REPRINTS Questions on reprints, permissions and syndication to ad_sales@thehealthcareblog.com.

WHAT WE COVER

HEALTHCARE, GENERAL

Affordable Care Act
Business of Health Care
National health policy
Life on the front lines
Practice management
Hospital managment
Health plans
Prevention
Specialty practice
Oncology
Cardiology
Geriatrics
ENT
Emergency Medicine
Radiology
Nursing
Quality, Costs
Residency
Research
Medical education
Med School
CMS
CDC
HHS
FDA
Public Health
Wellness

HIT TOPICS
Apple
Analytics
athenahealth
Electronic medical records
EPIC
Design
Accountable care organizations
Meaningful use
Interoperability
Online Communities
Open Source
Privacy
Usability
Samsung
Social media
Tips and Tricks
Wearables
Workflow
Exchanges

EVENTS

TedMed
HIMSS South x South West
Health 2.0
WHCC
AHIP
AHIMA
Log in - Powered by WordPress.